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Increase in illicit use
See also: Gray death
A November 2016 article in Time, “Heroin Is Being Laced With a Terrifying New Substance: What to Know About Carfentanil”, reports over 300 cases of overdose related to fentanyl and fentanyl analogues and several deaths connected to the drug since August 2016 in several of the United States, including Ohio, West Virginia, Indiana, Kentucky and Florida. In 2017, a Milwaukee, Wisconsin man died from a carfentanil overdose, likely taken unknowingly with another illegal drug such as heroin or cocaine. Carfentanil is most often taken with heroin or by users who believe they are taking heroin. Carfentanil is added to or sold as heroin because it is less expensive, easier to obtain (until China added it to its list of controlled substances on 1 March 2017, it was legal for Chinese firms to advertise and sell carfentanil over the Internet, offering advice to customers in other countries on how to import it illegally) and easier to make than heroin. Health professionals are increasingly concerned about the potential escalation of public health consequences of its recreational use.